Heart Failure Flashcards
What is the definition of chronic heart failure (CHF)?
Cardiac structural and/or functional abnormality= dec cardiac output/ elevated intracardiac pressure at rest of during stress= typical symptoms (breathlessness/ ankle swelling/ fatigue) and signs (elevated jugular venous pressure, pulmonary crackles, peripheral oedema)
cardiac structure/ function problem= failure of heart to deliver oxygen at rate required for metabolising tissues
1-2% of population -> >10% in over 70 years old
What is left ventricular heart failure/ diastolic dysfunction?
Left side of heart needs to work harder to pump the same amount of oxygen rich blood to the body, recieves oxygenated blood from the lungs to the left atrium, which then travels to the left ventricle, which it then pumps to the rest of the body
What is right ventricular heart failure/ systolic dysfunction?
Heart needs to work harder to pump the same amount of deoxygenated blood to the lungs, which it recieves from the body, to the right atrium, then to the right ventricle
Biventricular heart failure?
Both right and left ventricles fail. They aren’t mutually exclusive.
What is the cardiac output?
Litres of the blood the heart pumps through the circulatory system in a minute
CO= Heart rate x stroke volume (vol of blood pumped by the left ventricle expressed in mls)
what is the ejection fraction?
% of blood left ventricle can pump out with each contraction, stroke volume (ml) / total volume (110ml)
what is systolic heart failure?
when the heart can’t pump blood hard enough- insufficient pumping action/ impaired contraction, ejection fraction <40%, 40-50% borderline
what are the causes of systolic dysfunction?
chronic hypertension, ischemic heart disease,
dilated cardiomyopathy,
myocarditis
what is diastolic dysfunction?
dec compliance of the ventricle walls= insufficient filling
what are the causes of diastolic dysfunction
hypertension with left ventricular hypertrophy hypertrophic cardiomyopathy restrictive cardiomyopathy fibrosis sarcoidosis amyloidosis constrictive pericarditis hemochromatosis aging
what are the symptoms of heart failure
- SOB- exertion and lying down
- Fatigue and weakness
- Swelling (oedema) in legs, ankles and feet
Left sided failure
- fatigue
- exertional dyspnea
- paroxysmal nocturnal dsypnea
- orthopnea
- fatigue
- tachycarida
- tachypnea
- cyanosis
- confusion
- restlessness
pulmonary congestion
- cough
- crackles
- wheezes
- blood tinged sputum
what are the symptoms of right sided heart failure?
fatigue inc jugular veins inc peripheral venous pressure ascites dependant edema weight gain anorexia and complaints of GI distress enlarged liver and spleen may be secondary to chronic pulmonary problems
How to classify heart failure based on symptom severity?
Class 1: cardiac disease but no symptoms and limitations on ordianry physical activity class 2: cardiac disease with mild symptoms and mild limitations during ordinary activity class 3: cardiac disease with severe symptoms which limit activity, only comfortable at rest class 4- cardiac disease with symptoms severely limiting even at rest
What are the signs of left sided heart failure?
- crackles in lung bases initially, then throughout lung fields if left untreated
- displaced apex beat
- gallop rhythm
- and signs of right sided heart failure
What are the signs of right sided heart failure?
-raised JVP
-ascites
-organomegaly (liver and spleen)
- lower limb and sacral pitting edema
(( right sided heart failure= blood backed up = swelling to veins, interstital space and organs))
What are the investigations for heart failure?
ecg chest xray echocardiogram brain naturetic peptide (BNP) cardiomyopathy screen
maybe: MRI, angiopgraphy, transoesophageal echo, dobutamine stress echo (DSE)
what is the time course of heart failure?
acute, chronic, acute on chronic/ decompensated
what are the goals of treatment for heart failure?
identify underlying cause + treat, dec cardiac workload, dec cardiac stress, counteract maladaptation, dec symptoms, improve quality of life (decs hospitalisation)
management of acute heart failure?
- sit patient up,
-high flow oxygen, - IV diuretics at escelating doses,
- cons IV nitrates (caution in hypotension and heart failure secondary to severe aortic stenosis)
- consider IV opiates and anti-emetics,
- cons inotropic support,
- cons device therapy (intra-aortic balloon pump/ impella device),
cons referral for left ventricular assist device (bridge or destination therapy) or cardiac transplantation
how do you manage chronic heart failure?
diuretics for symptoms ace inhibitors beta blockers (not in acute decompensation or patients with signs of pulmonary oedema) mineralocorticoid receptor antagonist ivabridine arni ismn/hydralazine (if can't take acei or arb) consider crt/ icd consider cardiac transplantation
